A controversial amendment that would prohibit the Indian Health Service from paying for abortion except in the case of rape, incest against a minor, or to save the life of the mother, was approved by the U.S. Senate on Feb. 26.

Sens. Ted Stevens and Lisa Murkowski, both R-Alaska, voted in favor of the amendment. The amendment was not subject to a public hearing.

The amendment could have far-reaching implications in Alaska, which, according to the 2000 U.S. Census, has the largest American Indian or Alaska Native percentage of any state.

Meanwhile, two bills relating to abortion issues are moving though the Alaska Legislature. One would require parental consent for teens and another banning so-called partial birth abortions.

The Indian Health Service is an agency within the U.S. Department of Health and Human Services. It is responsible for providing federal health services to American Indians and Alaska Natives. Currently, the IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states.

The Vitter amendment - named for its sponsor, Louisiana Republican David Vitter - is part of the Indian Health Care Improvement Act reauthorization bill, which would authorize $35 billion over the next decade for the IHS to expand its coverage and services. The Senate voted 83-10 to approve the act on Feb. 26.

Although a 1976 amendment restricts the use of federal funds for abortions, Congress must renew it each year. The Vitter amendment would apply previous restrictions permanently to IHS beneficiaries.

"My amendment codifies a long-standing policy that prohibits the use of federal dollars for abortions," Vitter said. "The (previous) amendment represented a pivotal moment in the pro-life movement by restricting the use of federal funds for abortions, but a series of loopholes has allowed this practice to continue in certain instances. The passage of my amendment will finally close this loophole."

Changes in the makeup of both the state's and nation's high courts have given pro-life activists renewed vigor. The recent appointments of Chief Justice John Roberts and Associate Justice Samuel Alito by President George Bush to the U.S. Supreme Court meant a decision to uphold the constitutionality of Partial-Birth Abortion Ban Act was handed down last April.

Alaska Gov. Sarah Palin recently appointed Daniel Winfree to the Alaska Supreme Court. When Palin was running for lieutenant governor in 2002, she sent an e-mail to the Alaska Right to Life Board saying she was as "pro-life as any candidate can be." She is also belongs to the pro-life group Feminists for Life.

Though it could affect thousands of Alaska women, Vitter's amendment received scant attention in the state. Karen Lewis, executive director for Alaska Right to Life, said she had been "hoping the amendment would pass," but as of March 6 wasn't aware that it had.

"I'm thrilled to hear it passed," Lewis said. "I'm very pleased both of our senators got behind the Vitter amendment. Even those that are in favor of abortion should be able to get behind the Vitter bill because the majority of people do not want their tax dollars spent on abortion."

More than half a dozen measures that would limit abortion are currently working their way through the Alaska Legislature.

Two stand out. One would make the intact dilation and extraction method of abortion - commonly known as partial birth abortion - a felony for the provider in Alaska. The other would require parental notification and consent for underage girls seeking an abortion.

According to Clover Simon, executive director of Planned Parenthood of Alaska, hot-button social issues generally come to the forefront during an election year.

"Abortion is an excellent polarizing issue, which helps to mobilize the conservative voter base at the expense of women's health," Simon said. But the Vitter amendment "doesn't really change anything," she added. "All it did was reiterate what was already in place. The Indian Health Service didn't fund abortions to begin with."

Derek Townsend, legislative director for the National Right to Life committee, said the amendment "takes a policy which is in a vulnerable state and puts it on a firm statutory foundation. That's a significant thing. Opponents of the amendment say it's unnecessary and duplicative, and at the same time it's terrible, awful. Well, which is it?"

Townsend said he expects the House to adopt the amendment, but he worries that "strong-arm tactics by pro-abortion groups will prevent a vote on this issue, which would put the bill at great risk."

Verna Miller, public affairs specialist for the Indian Health Service in Washington, D.C., said the IHS cannot comment on the amendment because it hasn't gone before the House. "The bill could change, or it could remain the same," Miller said. "It's too soon to tell. It would be like putting the cart before the horse."

There were 1,701 abortions performed in the state in 2007, according to a report released last month by the Alaska Department of Health and Social Services Bureau of Vital Statistics. Of those, roughly a quarter - or 423 abortions - was performed on Alaska Native women.

According to U.S. Department of Justice statistics, rape in American Indian and Alaska Native communities is 3.5 times higher than among all other racial groups. Regardless of race, women living in rural Alaska have limited access to health care, contraceptives and abortion services. According to the nonprofit Alaska Pro-Choice Alliance Foundation, only Anchorage, Palmer, Fairbanks and Kenai have abortion providers.

"Women who live in rural Alaska all face the same health care barriers," Planned Parenthood's Simon said. "All women need to have all the options available to them, regardless of their situation. The consequences of rape and incest can be very difficult - if women want to choose abortion, it should be available to them."

Planned Parenthood provides sex education for both teens and adults. In rural Alaska the organization utilizes a "train the trainer" model, where a village member receives training and is then responsible for disseminating that information to his or her community, Simon said.

Alaska Right to Life's Lewis said her organization does not have any formal efforts to educate rural Alaskans, "but I personally would like to teach abstinence education in all the public schools, including those in rural Alaska. Our nation promotes promiscuity and depravity, and our young women need a message of valuing and protecting themselves."

National Right to Life's Townsend said the organization has a satellite group that targets American Indians and Alaska Natives, "but abortion is not something that comes out of Native cultural traditions anyway."

The Alaska Native Tribal Health Consortium, a nonprofit organization that manages Alaska Native health services, endorses passage of the Indian Health Care Improvement Act, but would not offer an opinion on the Vitter amendment.

The consortium believes there's no need for the amendment, said Valerie Davidson, ANTHC's senior director of legal and intergovernmental affairs.

It's unclear how accessible contraceptives are in rural Alaska, and whether birth control availability would lower the abortion rate.

The statistic that American Indian and Alaska Native women are 3.5 times more likely to suffer from rape, incest and sexual assault "represents the tragedy that affects many Native American women," Davidson said. "Their situations should not be politicized, nor should their options be restricted."

According to Planned Parenthood of Alaska, the average cost per year of birth control plus annual exam is $360. In Anchorage, the average out-of-pocket cost for an abortion is somewhere between $600 and $700. The average cost of a birth is several thousand dollars, "but it can be much more if a woman has an unhealthy or high-risk pregnancy," Simon said. In some instances, she said, the Alaskan Alliance for Reproductive Justice provides loans to Alaskan women who could not otherwise afford an abortion.